Original articleSubmacular Hemorrhage in Polypoidal Choroidal Vasculopathy Treated by Vitrectomy and Subretinal Tissue Plasminogen Activator
Section snippets
Study Design and Patients
This study was a prospective, interventional case series and all investigations adhered to the tenets of the Declaration of Helsinki. Each patient was informed about the risks and benefits of the surgery and participation in this research study. Their written informed consent for both the surgery and participation in this research study was obtained. The study was approved by the Institutional Review Boards of Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Anatomical Results
Submacular hemorrhages had been successfully moved away from the macula to the inferior periphery in all eyes during surgery and were absorbed thereafter. In all eyes, postoperative anti-VEGF therapy was administered as necessary and exudative and/or hemorrhagic manifestations attributable to polypoidal lesions had resolved completely by the patients' final visits. In addition, inner segment ellipsoid zones were detectable in the macula in 11 of 15 eyes (73%) at these final visits.
Postoperative Visual Outcome
Mean BCVAs at
Discussion
At present, the treatment options available for submacular hemorrhage can be broadly divided into “nonvitrectomizing techniques” and “vitrectomizing techniques.” Both approaches have been combined with intravitreal injection of t-PA or anti-VEGF or gas or a combination of these.4, 5, 6, 7, 8, 9, 10, 11 However, the intravitreal injection of gas into nonvitrectomized eyes can cause sudden retinal detachment and vitreous hemorrhage.6, 7, 8, 9, 10 Using a vitrectomizing technique it is possible to
Shuhei Kimura, MD, PhD, is an Assistant Professor, Department of Ophthalmology, Okayama University, Okayama, Japan. After graduation of Okayama University Graduate School of Medicine, he completed the residency in ophthalmology and retina fellowship at Okayama University Hospital. He specializes in vitreoretinal surgery.
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Shuhei Kimura, MD, PhD, is an Assistant Professor, Department of Ophthalmology, Okayama University, Okayama, Japan. After graduation of Okayama University Graduate School of Medicine, he completed the residency in ophthalmology and retina fellowship at Okayama University Hospital. He specializes in vitreoretinal surgery.